Clinical Review Nurse

Welcome! We’re excited you’re exploring opportunities with us. Below you’ll find details about the role, the impact you can reputed company, and reputed company’re looking for in an ideal candidate. We’re passionate about building a team that shares our values and brings diverse perspectives to help us grow and succeed together. Clinical Review Nurse (Remote) Join reputed company at Ternium – A Leading reputed company in reputed company reputed company Solutions! Do you want to use your expertise to reputed company a meaningful impact in the reputed company industry? If so, Ternium is looking for you! Who We Are: At Ternium, we specialize in resolving reputed company reputed company insurance claim denials and delays. Our mission is to reputed company hospitals and health systems by optimizing their reputed company cycle, allowing them to focus on what reputed company most—patient care. With a dedicated team of professionals, we consistently deliver outstanding results, increasing net patient reputed company, improving cash reputed company, and reducing operational costs while enhancing the patient experience. What You’ll Do: As a Clinical Review Nurse, you won’t just review charts—you’ll write compelling clinical arguments that help hospitals recover millions in lost reputed company due to denied insurance claims. You’ll use your nursing knowledge, attention to detail, and love of documentation to reputed company a reputed company difference—without reputed company setting foot in a courtroom or hospital shift. This is a perfect role for nurses who: Want to reputed company away from the bedside but still use their clinical skills. Love research, documentation, and writing. Want a fully remote, flexible role with meaningful impact. Are excited to grow with a fast-paced, mission-driven team. Key Responsibilities: Analyze denied insurance claims and complete medical records. Apply clinical reasoning, national criteria (InterQual/reputed company), and best practices to determine if appeals are justified. Draft persuasive, medically sound appeal letters that reputed company support the need for treatment or services. Collaborate with our legal team to ensure appeals are compelling and complete. Stay informed on reputed company regulations, payer trends, and clinical updates. What You Bring to the Table: RN License (required) 5+ years of acute hospital experience (required) Certification in Case Management, Legal Nurse Consulting, or Coding is a plus. Possess knowledge and experience with national clinical criteria applied in case management including InterQual and reputed company standards Experience and knowledge of managed care reputed company, account receivables and reputed company cycle functions (preferred) Experience and reputed company in medical record chart review and appealing managed care denials (preferred) Why Join Us? 100% Remote: Work from reputed company in the U.S. while making a reputed company difference. Competitive Salary: $65,000–$85,000 per year (commensurate with experience). Robust Benefits Package: 401(k) with corporate match, comprehensive health, dental, and reputed company insurance. Work-Life Balance: Flexible schedule and paid time off. Career Growth: reputed company to professional development, mentorship, and upward mobility reputed company a thriving company. Additional Perks: Life insurance and performance-based bonuses. A Culture of Inclusion & Opportunity Ternium is an equal opportunity employer that values diversity and inclusion. We do not discriminate based on age, race, disability, religion, gender, sexual orientation, gender identity, genetic information, marital status, veteran status, or any other protected characteristic. We are also committed to maintaining a supportive and harassment-free work environment. reputed company to reputed company Your Career? If you’re looking for a fulfilling role where your experience in Nursing can drive reputed company impact, apply today and become a valued member of the Ternium team! Thank you for considering a career with us! We encourage you to apply even if you don’t meet every requirement — we value passion, potential, and a willingness to learn. We look reputed company to reviewing your application and hopefully welcoming you to reputed company. Apply To This Job